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The Tinnitus Clinic is staffed by professionally master-qualified practitioners with extensive experience in tinnitus management. We do not sell hearing aids or profit from anything other than our professional services. We have no fiduciary interest in external sources. MSc (King's), MSSc, BHSc. John Wibrow is a graduate of the University of South Australia with degrees in electronic engineering and health science. He also holds post graduate qualifications in management and social science and is a Masters-qualified counsellor with a particular interest in the neuroscience of tinnitus. John also has a Masters in Applied Neuroscience from King's College London and is a full member of the Applied Neuroscience Society of Australasia (ANSA) and the International Society for Neurofeedback & Research (ISNR). John is also a professional registered clinical counsellor and is a clinical member of the Psychotherapists and Counselling Federation of Australia (PACFA). He is also registered with the Australian Register of Counsellors and Psychotherapists (ARCAP). He has a strong interest in tinnitus trauma and the psychological impact of tinnitus on people with this condition and their families. John has a deep personal understanding of tinnitus having had the condition since 1994. He was instrumental in obtaining government funding for the establishment of the first Government-funded tinnitus clinic in Australia. John was also co-founder of the Tinnitus Advisory Group (TAG) and was its President for eight years. John also co-authored the video “Tinnitus - Let’s Be Positive” and is currently writing a book “Recovery From Tinnius Distress”. John is co-founder of the Tinnitus Clinic and utilises a combination of techniques such as person-centred counselling, trauma counselling, neurofeedback, and behavioural therapy techniques, BA, MA. Marta Lohyn is a psychologist who specialises in the use of clinical hypnosis for a range of difficulties. She has been working clinically with adults and children for 30 years and has found hypnosis to be an invaluable tool in assisting clients to deal with problems like anxiety, depression, sleep problems and chronic pain. Marta joined the Executive Committee of the south Australian Society of Hypnosis as treasurer in 2009 and in 2010 was invited to undertake the role of Director of Studies. In this role she developed and coordinated the training course, also taking a significant part in the teaching program. Marta has also conducted training for the Australian Society of Hypnosis (ASH) and is co-director of Hypnosis Today, which offers training in hypnosis to registered health professionals. Marta is co-founder of the Tinnitus Clinic and has become involved in the tinnitus area through her collaboration with John. As well as her considerable experience as a psychologist and counsellor, with hypnosis Marta offers tinnitus clients a very relaxing and powerful tool to reduce their perception of tinnitus and manage their distress and discomfort more effectively. Marta is also a full member of the the Applied Neuroscience Society of Australasia (ANSA).

The Tinnitus Clinic provides expert tinnitus treatment using scientific and evidence-based techniques of tinnitus specialised tinnitus counselling, neurofeedback, and hypnosis. The Tinnitus Recovery Program is located in East Adelaide, South Australia. Tinnitus Clinic Specialists in evidence-based Tinnitus Recovery 8333 1010 Talk to experts who understand the whole auditory pathway from ear to brain. FREE NO OBLIGATION INITIAL PHONE CONSULT Reduce your tinnitus distress and perception NOW - unique trimodel treatment approach John Wibrow MSc. MSSc. BHSc. Neuropsychotherapist Marta Lohyn MA, BA Psychologist Reduce tinnitus intrusiveness Increase sense of control Reduce cognitive interference Reduce sleep disturbance Reduce auditory difficulties Increase ability to relax Improve Quality of Life Reduce emotional distress Welcome to the Tinnitus Clinic, a specialist provider of professional tinnitus treatment services aimed at reducing your perception of tinnitus and associated distress. The founding principals John Wibrow and Marta Lohyn have collectively over 40 years of experience in counselling, psychotherapy, hypnosis and tinnitus management. You can therefore expect to receive compassion, understanding, and therapeutically beneficial treatment approaches which will assist you to overcome issues such as trauma, distress, attention, awareness, anxiety, depression, etc. relating to your tinnitus experience. You can also expect to receive a thorough assessment which is undertaken within guidelines defined by the Tinnitus Research Initiative protocols and in consultation with other treating specialists in the fields of general practice, otorhinolaryngology, neurology and audiology. Our treatment approaches are based on the neuro-scientific concepts derived from scientific research relating to brain plasticity and brain state changes and utilise a combination of counselling, neurofeedback, and hypnosis. Our clients report significant reductions in their tinnitus perception and measurable reductions in their levels of anxiety and tinnitus distress. Client Testimonials Unique Trimodal Evidence-Based Approach Experience - Innovation - Results The Tinnitus Clinic provides professional evidence-based clinical services that draws from current research understanding of the neuroscience behind tinnitus and which aim to influence brain states in the treatment of tinnitus. We have developed a unique trimodal evidence-based treatment model which utilises a combination of tinnitus counselling, neurofeedback and hypnosis to therapeutically influence brain plasticity and cognitions which have shown to reduce the perception of tinnitus. Our clinical protocols are guided by those principles outlined by the Tinnitus Research Initiative (TRI). Tools for assessment and evaluation are based on established international questionnaires for tinnitus research. Our services are provided within a sound and ethical context based on professional and evidence-driven protocols for the treatment of tinnitus. Neurofeedback Hypnosis Tinnitus Retraining Counselling Treatment Evidence Set Up Treatment Analysis Change brain-states Reduce tinnitus perception & distress Latest EEGer Neurofeedback Hardware and Software See results in real-time Real-time analysis to determine change in brain-states Neurofeedback Hypnosis Hypnosis is a highly focussed state of attention during which we can perceive and experience things differently. In our daily life we often experience this highly focussed and somewhat detached state, for example, when we are day dreaming or absorbed in a book, or the computer, or watching TV or a film. But when hypnosis is used in the clinical setting, it can help us to make changes we want to achieve by building skills and strengthening inner resources to overcome particular difficulties and problems. So the contemporary understanding of hypnosis is that it is a natural ability we all have (to a greater or smaller extent as we are all different) that we can use in a clinical setting to make desired changes. With the development of knowledge in the field of neuro-science, we now know that when we are in this highly focussed state of attention, our brains process information differently although knowledge about what happens in the brain during hypnosis is still in its infancy. But what we do know is that when we are focused in this way, we can be especially responsive to new ideas and possibilities that can help us make desired changes. That is, when we are in hypnosis, we are more receptive to suggestions. Most importantly, however, there are studies (see Resources) which show that hypnosis can be effective in the treatment and management of tinnitus; whilst research into hypnosis and tinnitus is not extensive, it is encouraging and consistent with feedback received to date from our tinnitus clients. Hypnosis can help people with tinnitus become less distressed about the tinnitus and more positive and skilled at managing it. It can sometimes also help with reducing the experience of the tinnitus. Is hypnosis like being asleep or unconscious? No, hypnosis is not sleep or being unconscious but generally when used clinically, people are likely to be very relaxed while in hypnosis. Does the practitioner have power over clients, and can they be made to do things they would not normally do? No, this myth comes from people seeing stage hypnosis, where subjects are often chosen because of their extreme willingness to go along with the show. In a clinical setting, the purpose of using hypnosis is to help clients achieve their goals, and the relationship between the client and practitioner is one of collaboration and care, not control by the practitioner. Can everyone be hypnotised? Most people are capable of experiencing hypnosis and using it for their own positive purposes. Some people are extremely responsive; some are less responsive, but most people will benefit from hypnosis with a trained and skilled practitioner. Is hypnosis simply relaxation? No, hypnosis is not just relaxation, although often, when in hypnosis, the person may feel particularly relaxed. However, in hypnosis, the client is mentally active and processing what is being said to them. Also, it is possible to be in hypnosis whilst being physically active. For example, runners can have the experience of "zoning out" whilst running; they are working hard physically, but their minds are highly focused on something else, such as music. There are other examples in war, or sports, where people can lose awareness of pain whilst physically active. Is hypnotherapy the same as hypnosis? Although some practitioners refer to themselves as hypnotherapists, hypnosis is really a tool that can be used to deliver or reinforce a particular therapeutic approach. The research shows that hypnosis enhances the outcomes achieved using cognitive behavioural therapy and other psychological therapies. Clinicians find that with the addition of hypnosis, similar or better results are achieved, and in a much shorter time frame. Tinnitus Counselling SUPPORT COMPASSION UNDERSTANDING For some, the onset of tinnitus can be a traumatic experience which may involve feelings of grief and loss as well as emotional and/or physical depletion. Appropriate and early counselling intervention can have a profound and positive impact on tinnitus coping and habituation. Tinnitus Counselling offers the understanding and support that can really make a difference for those distressed by their tinnitus. Each individual is affected differently by their tinnitus experience and each individual processes tinnitus distress differently. For some, the onset of tinnitus can be traumatic and this may require specialised counselling skills which are non-directive and encourage exploration of what is important to the individual and what is needed right now. Also, the physical and psychological fall out from tinnitus requires compassion and support and if the tinnitus experience involves distress then individuals may benefit from speaking to a counsellor trained in trauma counselling, and who understands tinnitus and can draw on personal understanding and experience. A client-centred counselling approach is imperative in all cases as this facilitates greater discussion of those areas important to the client. Through this process, the counsellor assesses the level of understanding and needs of the client and adjusts their counselling appropriately. Appropriate counselling can reassure, inform, and empower individuals who need support and this can occur at many stages in the treatment process as the individual is appropriately assessed by other health professionals.

Local, interstate, and international inquiries are welcomed. Step 1 Call the clinic at 8333 1010 for a free, no-obligation initial consultation. Step 2 The Tinnitus Clinic will assess your tinnitus status and determine your suitability for treatment by the tinnitus clinic. Further investigations by other health professionals may be suggested. At this time, an initial consultation date/time will be mutually agreed upon, or you may choose to wait until you have considered further information. Step 3 You will be sent an information pack containing two questionnaires, a personal details form, and a request for relevant medical reports (e.g., Scan report, specialist's report, audiological report, etc.). Step 4 You will attend the initial consultation for approximately 1.5 - 2 hrs. During this time, four aspects of your tinnitus will be considered: A thorough assessment of your tinnitus and the possible triggers. A detailed explanation of the current understanding of the neurophysiological model of tinnitus and how this relates to your onset of tinnitus. Discussion of self-management strategies and/or further recommended investigations/treatments. A brief overview of our trimodal 12-week tinnitus recovery program. Clients may choose to consider our 12-week tinnitus recovery program. There are no up-front fees, and clients can withdraw from the program at any time. Payment is on a per-weekly basis. Private health fund rebates apply.

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The Tinnitus Clinic provides professional evidence-based clinical services that draws from current research understanding of the neuroscience behind tinnitus and which aim to influence brain states in the treatment of tinnitus.We have developed a unique trimodal evidence-based treatment model which utilises a combination of tinnitus counselling, neurofeedback and hypnosis to therapeutically influence brain plasticity and cognitions which have shown to reduce the perception of tinnitus. References Abdallah, C. G., Averill, C. L., Ramage, A. E., Averill, L. A., Goktas, S., Nemati, S., ... & STRONG STAR Consortium. (2019). Salience network disruption in US Army soldiers with posttraumatic stress disorder. Chronic Stress, 3, 2470547019850467. Aljandali, A. (2016). Quantitative analysis and IBM® SPSS® statistics. Springer International Publishing. https://doi.org/10.1007/978-3-319-26198-9 Barrenechea, F. V. (2022). 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L., & Greicius, M. D. (2007). Dissociable intrinsic connectivity networks for salience processing and executive control. The Journal of Neuroscience, 27(9), 2349–2356. https://doi.org/10.1523/JNEUROSCI.5587-06.2007 Sidlauskaite, J., Sonuga-Barke, E., Roeyers, H., & Wiersema, J. R. (2016). Altered intrinsic organisation of brain networks implicated in attentional processes in adult attention-deficit/hyperactivity disorder: a resting-state study of attention, default mode and salience network connectivity. European archives of psychiatry and clinical neuroscience, 266, 349-357. Simoes, J. P., Daoud, E., Shabbir, M., Amanat, S., Assouly, K., Biswas, R., Casolani, C., Dode, A., Enzler, F., Jacquemin, L., Joergensen, M., Kok, T., Liyanage, N., Lourenco, M., Makani, P., Mehdi, M., Ramadhani, A. L., Riha, C., Santacruz, J. L., & Genitsaridi, E. (2021). Multidisciplinary tinnitus research: Challenges and future directions from the perspective of early-stage researchers. Frontiers in Aging Neuroscience, 13, Article 647285. https://doi.org/10.3389/fnagi.2021.647285 Stubbe, D. E. (2018). Emerging therapies: Communication, consent, and collaboration in research-based treatment. Focus, 16(3), 289–291. https://doi.org/10.1176/appi.focus.20180015 Tabachnick, B. G., & Fidell, L. S. (2018). Using multivariate statistics (7th ed.). Pearson. https://books.google.com.au/books?id=cev2swEACAAJ Tailor, B. V., Thompson, R. E., Nunney, I., Agius, M., & Phillips, J. S. (2021). Suicidal ideation in people with tinnitus: A systematic review and meta-analysis. The Journal of Laryngology & Otology, 135(12), 1042-1050. https://doi.org/10.1017/S002221512100234X Teng, C., Liu, T., Zhang, N., Zhong, Y., & Wang, C. (2022). Cognitive behavioral therapy may rehabilitate abnormally functional communication pattern among the triple-network in major depressive disorder: A follow-up study. Journal of Affective Disorders, 304, 28-39. https://doi.org/10.1016/j.jad.2022.03.070 Teng, C., Zhang, W., Zhang, D., Shi, X., Wu, X., Qiao, H., Zhang, N., Hu, X., & Guan, C. (2024). Association between clinical features and decreased degree centrality and variability in dynamic functional connectivity in obsessive–compulsive disorder. NeuroImage: Clinical, 44, 103665. https://doi.org/10.1016/j.nicl.2024.103665 Tolin, D. F., McKay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatment: Recommendations for a new model. Clinical Psychology: Science and Practice, 22(4), 317. Trevis, K. J., McLachlan, N. M., & Wilson, S. J. (2018). A systematic review and meta-analysis of psychological functioning in chronic tinnitus. Clinical psychology review, 60, 62-86. Uddin, L. Q. (2016). Salience network of the human brain. Academic Press. https://doi.org/10.1016/C2013-0-19171-7 Vlachou, J. A., Polychroni, F., Drigas, A. S., & Economou, A. (2022). Neurofeedback and ADHD. International Journal of Recent Contributions from Engineering, Science & IT (iJES), 10(01), 47-56. Xiong, B., Liu, Z., Li, J., & et al. (2023). Abnormal functional connectivity within default mode network and salience network related to tinnitus severity. Journal of the Association for Research in Otolaryngology, 24, 453–462. https://doi.org/10.1007/s10162-023-00905-2 Yoshino, A., Okamoto, Y., Okada, G., Takamura, M., Ichikawa, N., Shibasaki, C., & Yamawaki, S. (2018). Changes in resting-state brain networks after cognitive–behavioral therapy for chronic pain. Psychological Medicine, 48(7), 1148-1156. https://doi.org/10.1017/S003329171700288X Zeman, F., Koller, M., Langguth, B., Landgrebe, M., & Tinnitus Research Initiative Database Study Group. (2014). Which tinnitus-related aspects are relevant for quality of life and depression: results from a large international multicentre sample. Health and quality of life outcomes, 12, 1-10. Zenner, H. P., Delb, W., Kröner-Herwig, B., & et al. (2017). A multidisciplinary systematic review of the treatment for chronic idiopathic tinnitus. European Archives of Oto-Rhino-Laryngology, 274, 2079–2091. https://doi.org/10.1007/s00405-016-4401-y Zhou, G. P., Li, W. W., Chen, Y. C., Wei, H. L., Yu, Y. S., Guo, X., ... & Zhang, H. (2022). Disrupted intra-and inter-network connectivity in unilateral acute tinnitus with hearing loss. Frontiers in Aging Neuroscience, 14, 833437. Zimmerman, B., Finnegan, M., Paul, S., Schmidt, S., Tai, Y., Roth, K., ... & Husain, F. T. (2019). Functional brain changes during mindfulness-based cognitive therapy associated with tinnitus severity. Frontiers in Neuroscience, 13, Article 747. https://doi.org/10.3389/fnins.2019.00747

The Neuroscience of Tinnitus Emerging neuroscientific research describes tinnitus as dysregulation across three primary brain networks: the salience network (SN), the default mode network (DMN), and the central executive network (CEN) (De Ridder et al., 2014, 2022). First described by Menon (2011) as the triple network model (TNM), functional connectivity (FC) across these brain regions plays a distinct role in certain psychopathology: the SN is responsible for enhancing the salience of sensory input (Uddin, 2016); the DMN governs self-referential thought, which influences cognitive and emotional processing (Buckner et al., 2008); and the CEN regulates priority cognitive functions that influence attention and executive decisions (Seeley et al., 2007). Recent neuroimaging studies consistently show abnormal FC within TNM regions among tinnitus sufferers. For example, Chen et al. (2018) investigated how tinnitus perception and distress correlates with altered FC within the TNM using functional magnetic resonance imaging (fMRI) and seed-based correlation analysis. Fifty chronic tinnitus participants were compared with fifty controls, matched for age and gender, and hyperactivity was observed between the SN and DMN in tinnitus participants which positively correlated with tinnitus handicap inventory (THI) scores, a validated measure of tinnitus impact (Newman et al., 1998). In contrast, hypoactivity was observed between the DMN-CEN in tinnitus participants which correlated with heightened emotional response and attentional focus on tinnitus. Zhou et al. (2022) also demonstrated that tinnitus is linked to disruptions in FC within the TNM. In a fMRI and seed-based functional connectivity analysis, forty-five chronic tinnitus participants and forty-five healthy controls were matched for demographic variables such as age and gender. Distress levels were measured using the tinnitus handicap inventory (THI) and tinnitus functional index (TFI) to assess tinnitus impact on emotional and functional domains. Elevated SN-DMN connectivity and reduced DMN-CEN connectivity were observed in tinnitus participants, which positively correlated with levels of tinnitus distress and perception. De Ridder et al. (2022) posits that increased SN-DMN connectivity aligns with a neurological predisposition to engage in self-referential and distressful thoughts about tinnitus, whereas reduced DMN-CEN connectivity is associated with weakened cognitive regulation, contributing to difficulty in shifting attention away from the tinnitus. In a study using resting-state electroencephalography (rs-EEG), Xiong et al. (2023), specifically found enhanced connectivity between the SN’s anterior insula (AI) and auditory cortex, as well as between the DMN’s parahippocampal cortex (PHC) and posterior cingulate cortex (PCC). These patterns were more pronounced in moderate-to-severe tinnitus cases and were associated with higher levels of distress and attentional focus on tinnitus, as reflected by elevated THI and TFI scores. A consistent finding in tinnitus participants therefore appears to be SN-DMN and SN-CEN hyperactivity and DMN-CEN hypoactivity as depicted in Figure 1. Figure 1. Triple network model (TNM) of tinnitus showing dysregulation parameters. Non-invasive neuromodulation techniques that target these dysfunctional pathways are therefore of particular interest. Laundry et al. (2020) and Trevis et al. (2018) demonstrated that cognitive therapy (CT), including CBT, helps individuals reframe negative perceptions and reduce emotional distress associated with tinnitus. However, we must turn to related applications of CT to gain insights on its effect on TNM pathways. Yoshino et al. (2018) used resting-state fMRI (rs-fMRI) to show that chronic pain subjects who underwent cognitive therapy (CT) exhibited improved DMN-CEN regulation, which is particularly relevant given the parallels between the emotional responses to chronic pain and chronic tinnitus (De Ridder et al., 2022; Johansson et al., 2024). Comparable findings have been observed in disorders such as obsessive-compulsive disorder (OCD) (Fan et al., 2017) and major depressive disorder (MDD) (Pinto et al., 2014), which, like tinnitus, are characterised by disruptions in emotional and attentional brain networks (Cyr et al., 2020; Teng et al., 2022, 2024). Zimmerman et al. (2019) found that mindfulness based cognitive therapy (MBCT) increased DMN-CEN connectivity and regulation which positively correlated with a reduction in distress in tinnitus subjects. Bauer et al. (2017) used fMRI to demonstrate that CT increased DMN-CEN connectivity which correlated with reduced emotional reactivity and reduced tinnitus distress. Cognitive therapies therefore appear to have a specific role in modulating the DMN-CEN pathway which may explain why, as a monomodal therapy it is helpful in reducing tinnitus distress but not so for tinnitus perception which is more strongly associated with the SN pathways. However, the inclusion of CT in a multimodal approach clearly holds promise. Neurofeedback, a technique that trains individuals to regulate brainwave activity via real-time monitoring of EEG signals, has been successfully used to treat post-traumatic stress disorder (PTSD) (Vlachou et al., 2022) and attention deficit hyperactivity disorder (ADHD) (Reiter et al., 2016), two conditions which display hyperactivity in SN-DMN functional connections; a phenomenon also found in tinnitus sufferers (Abdallah et al., 2019; Sidlauskaite et al., 2016). When considered within the context of the triple network model, neurofeedback has been found to be a promising tool for modulating key brain networks implicated in tinnitus (Barrenechea, 2022). For example, Guntensperger et al. (2017, 2019), demonstrated that neurofeedback can modulate key regions of the DMN, such as the posterior cingulate cortex (PCC) which correlated with reduction in tinnitus-related distress. Similarly, Kleinjung et al. (2023) and Jensen et al. (2023) demonstrated that neurofeedback can downregulate hyperactivity of the SN-DMN and SN-CEN by neuromodulating the anterior insular (AI) and anterior cingulate cortex (ACC) regions involved in the perceptual salience and attentional focus on tinnitus. One challenge with neurofeedback research, however, is the variability across studies on the optimal training protocol (Rogala et al., 2016). Notwithstanding, a protocol developed by Crocetti et al. (2011) aimed at reducing delta and beta waves and increasing alpha activity, resulted in significant reductions in tinnitus perception, as evidenced by improved THI scores. This alpha/delta/beta training protocol has been refined by Jensen et al. (2020, 2023) and incorporated into the study design of this proposal. While speculative, neurofeedback potentially contributes to downregulating SN-DMN hyperactivity and therefore stands as a complementary component of a multimodal treatment approach to tinnitus. Hypnosis, a therapeutic technique that induces a state of focused attention and heightened suggestibility, has been shown to modulate brain networks associated with tinnitus perception and distress (Laundry et al., 2017). In neuroimaging studies, hypnosis demonstrated enhanced cognitive control by modulating the dorsolateral prefrontal cortex (dlPFC) and posterior cingulate cortex (PCC) of the DMN-CEN pathway, which is implicated in rumination, a feature also in tinnitus (Oakley & Halligan, 2013; Hammond, 2019). In a neuroimaging study by Deeley et al. (2012), reduced DMN activity, measured by fMRI, correlated with the depth of the hypnotic state compared to the alert state. Similar findings were reported by McGeown et al. (2009), who used fMRI to demonstrate that hypnotic induction significantly decreased brain activity in the prefrontal cortex (PFC) of the DMN compared with the no-hypnosis state. An fMRI study by Jiang et al. (2017) observed down-regulation of the DMN-CEN pathway in tinnitus sufferers which was countered by a hypnotic state and which also decreased hyperactivity between the SN and CEN, leading to greater emotional regulation of sensory input from the SN and a reduced state of arousal. A review by Bralic (2023) of neuroimaging evidence for clinical hypnosis and its relation to the triple network model (TNM) of psychopathology, concluded that hypnosis downregulates attentional and emotional neural pathways by modulating hypoactivity at both a DMN-CEN, and SN-CEN level, which demonstrates a complementary contribution within a multimodal treatment approach. In consideration of the triple network model (TNM) of tinnitus, it is evident from neuroimaging research, that cognitive therapy, neurofeedback, and hypnosis have a synergistic and complementary therapeutic neuromodulating effect on different functional connections of the TMN as depicted in Figure 2. Figure 2. Trimodal tinnitus treatment model showing areas of main influence from cognitive therapy, neurofeedback, and hypnosis. References

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Change your brain states and lower your tinnitus distress and perception through the use of specialised hypnosis recordings. Reduce tinnitus distress Reduce tinnitus perception Restore balance Change your brain states and lower your tinnitus distress and perception through the use of specialised hypnosis recordings. Hypnosis Recordings Website * Unique hypnosis recordings specific for people with tinnitus. * Developed by specialists in tinnitus management and recovery. * Based on many hours of clinical practice and client feedback. * Can be used anytime and anywhere to suit your personalised requirements. * Download to your electronic device for your convenience and ease of use. Reduce tinnitus distress Reduce tinnitus perception Restore balance

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Welcome to the Tinnitus Clinic, a specialist provider of professional tinnitus treatment services aimed at reducing your perception of tinnitus and associated distress. The tinnitus Clinic receives and welcomes referrals from medical specialists. Please email your referral to jwibrow@chariot.net.au and clinic@eastadelaide.com.au attention Director, John Wibrow. Correspondence to PO Box 493 Marden SA 5070. We invite you to explore this section for information on our services which we hope will provide you with the confidence that your client will be provided with therapeutically beneficial and eveidence-based treatment. We now know that tinnitus is not a disease of the auditory system alone. It has already been postulated by Jastreboff more than 20 years ago that the difficulty to ignore tinnitus, the annoyance of tinnitus, the anxiety that tinnitus becomes worse, the irritability and the concentration difficulties are related to functional changes in non-auditory brain systems. Neuroimaging studies in tinnitus patients have helped to identify the involved networks in detail. Thus altered activity in the central auditory pathways is not sufficient for tinnitus perception. This explains that many patients with hearing loss (and consequent increased activity in the central auditory pathways) do not perceive tinnitus. Only when the auditory activity is connected to activity in the “attentional network” the tinnitus is consciously perceived. If this activity is further accompanied by activation in a “distress network” the patient perceives tinnitus distress. Imaging studies have also demonstrated that the hippocampal area, which plays an important role for memory, is involved in chronic tinnitus. This finding indicates that there may be a “tinnitus memory”, which perpetuates tinnitus perception. Whether the tinnitus signal is perceived as important and whether the attention focus is kept on the tinnitus, depends on activation of the salience network. A high salience of the tinnitus signal in turn may increase the perceived loudness of tinnitus by causing increased amplification of the signal in auditory pathways. This principally useful mechanism of the brain to amplify important information results in case of tinnitus in a vicious circle that contributes to the perpetuation of tinnitus. Noteably it is important that the different brain networks involved in tinnitus may differ from patient to patient, depending on the specific clinical characteristics. Thus for example in people that are distressed by their tinnitus, the brain activity that is relevant for tinnitus perception is connected to increased activity in the distress network. Moreover earlier findings that the brain activation patterns changes with increasing tinnitus duration have been confirmed. This indicates the importance to differentiate between different forms of tinnitus. Many individuals with tinnitus have abnormal oscillatory brain activity. We have found that by using techniques which contribute to the normalization of such pathological activity (e.g. by neurofeedback, relaxation, hypnosis and counselling techniques) we obtain a significant reduction in tinnitus intensity and other factors as measured against the Tinnitus Handicap Questionnaire (THQ) and Tinnitus Functional Index (TFI) . Treatment Evidence

It is important to be supported during your tinnitus journey. Recovery is possible with the right support and help. CRISIS CARE CONTACTS The Tinnitus Clinic is not a helpline or crisis centre. If you are in crisis with your tinnitus, you must seek appropriate emergency care immediately. Please contact your healthcare professional and/or the emergency department of your local hospital for assistance. The following services may also be of assistance where crisis care is required: The following information is provided for general guidance and is not intended as a replacement for professional assessment and treatment. Please contact your healthcare provider in the first instance. 1. Maintain a rich sound environment. This helps to stimulate the auditory pathways and retrain your brain to defocus away from the tinnitus. \if you have significant hearing loss, consider the fitment of hearing aid(as) as appropriate. 2. Use ear protection when sound exposure is likely to cause hearing damage (e.g. loud concerts, occupational noise, movie theatre, prolonged dental work, etc). Ear protection should be selected depending on the situation (e.g. Musician’s ear plugs for concerts and movie theatre; ear muffs for industrial situations; noise cancelling headphones for long haul flights). 3. Avoid very quiet environments or blocking your ears or using ear plugs in normal sound level situations. This is particularly relevant in the early stages of tinnitus. Once you have habituated to your tinnitus and hardly ever notice it and are no longer distressed by your tinnitus, you will be able to enjoy very quiet situations again. 4. Do not be overly concerned about temporary spikes in your tinnitus which can occur from time-to-time as a result of reactive tinnitus to certain triggers such as car cabin noise when on a long trip, certain foods and drinks, medications, stress, dental treatment, neck and jaw problems, neuralgia, etc. For most people, the peak intensity eases over time. 5. Discuss your medications with your GP and/or treating specialist. Some medications or combinations of medications have been reported to trigger or exacerbate tinnitus or can cause damage to your hearing - ototoxic (e.g. Aspirin and certain antibiotics). 6. Remember that tinnitus perception is strongly correlated to your degree of stress and anxiety about tinnitus. Fear of tinnitus will enhance your attention to the tinnitus and contribute to distress and anxiety and this will increase your perception of tinnitus. As a consequence, what is a small tinnitus signal can be perceived as overwhelmingly loud as your auditory neural pathways amplify the internal sound. 7. Utilise any technique that reduces your anxiety levels such as relaxation, meditation, mindfulness, hypnosis, neurofeedback, yoga, tai chi, etc. It is important that you receive reassurance, understanding and support from a suitably qualified tinnitus counsellor. 8. The use of appropriately prescribed medication in the early stages of tinnitus is understandable and acceptable. If medication is of the benzodiazapine family, then possible addition and withdrawal is a consideration. Short-term and infrequent use is best. Slow withdrawal is important to minimise the chances of tinnitus spikes. 9. Remember that invariably tinnitus improves over time and in many people they become completely unaware of their tinnitus for most of the time. For some people, being aware of head or ear-sounds is a normal phenomenon. The most realistic goal is therefore to only be aware of your tinnitus when you listen for it or in very quiet situations. 10. Tinnitus perception and intensity invariably eases over time. However, if you become extremely distressed or affected by your tinnitus it is important to talk to someone about it. If you are in an emergency, or at immediate risk of harm to yourself or others, please contact emergency services and talk to someone now. GENERAL MANAGEMENT TECHNIQUES